Creation of database and structured information

ABSTRACT

A system through which verbal information can be utilized to create structured data with tags or inserted codes such as an XML code or the like provides hand held capability for easy adoption via CE, cell telephone, or other data entry devices. A visual display at the time of dictation can provide checklists, prompts or otherwise shape the entry to comport to a selected data context. The visual display can also be part of a transcriptionist system. By providing data in a coded fashion, analysis can be easily conducted such that alerts, bioterror alerts (e.g. evolving symptom or trend information for anthrax or the like) can be rapidly and perhaps automatically identified, and acted upon such as in providing health care alerts or locationally oriented statistical analysis information. A central database reporting function to a central authority (e.g., to the CDC or law enforcement) can be included for terrorist and other event management.

TECHNICAL FIELD

[0001] Generally, this invention relates to a computer-based system fortranscription and related information and other security and dataintensive information or the like. Specifically, the invention may focuson applications, methods, software, hardware, services, and evenbusiness methods which can provide a variety of functions important intranscribing or handling information, such as medical information,including but not limited to convenient transcription with menu datatailoring as may be of interest to some of the users of the particularinformation involved. It may involve handling the information through anetwork such as the global information network or Internet.Specifically, the invention focuses on applications, methods, software,hardware, services, and even business methods which can provide avariety of functions important in the handling of the information,including but not limited to access, research, and other such functions.It can provide a variety of functions important in the dealing with theinformation, including but not limited to encoding such information withdetails of interest to some of the users of such information.

BACKGROUND

[0002] One of the more inefficient environments in which to capture datais that from verbal information. Because verbal or perhaps dictatedinformation can use a variety of words or phrases for a singular meaningand because verbal information can be highly originator dependent, itcan be challenging to capture in a structured data format. But oneexample is that of the medical environment. This environment can presentnot only one for which the need can be acute (such as to help thepatient with a potentially fatal complication) but also one in which thestrictures and formats can range from one of insurance billing to one ofa need for immediate correlation of information. This is compounded bythe professional not having the time to enter the data manually.Moreover, the threat of bioterrorism has become the reality of abioterrorist attack. Although the technology used to attack was quitesimple, the consequences of the ensuing terror have been far reachingand profound. It has become vividly clear that attacks cannot beentirely prevented. Our best weapon then, is in the rapid collection andsharing of critical information and responding to bioterrorist attacks,a process that is entirely dependent on rapid, accurate andcomprehensive data capture.

[0003] In but one application, it can be understood that healthcare ingeneral and physician practices in particular, have not kept abreast ofdramatic improvements in the technology of data capture and management.As a direct result, all stake holders from patient to providers aresuffering. Technology solutions have not been adopted by the vastmajority of physicians, who for the most part, function as independentsmall groups focused on patient interaction and patient care, and havelittle time or patience with high tech solutions. It is, however, quiteclear that this is a fragmented market and a giant of a market waitingbreathlessly for a palatable solution.

[0004] In the medical example, physicians are sometimes quoted as losingmoney at the rate of up to $60,000 per physician per year because of thecomplexity of a reimbursement system that literally forces them tochoose from millions of possible coding combinations in order to getpaid. Driving the revenue loss is the stem gaze of the government andthe threat of monetary and even criminal penalties should physicians erron the side of over-charging for their services. Incomplete fragments ofpatient information are literally hidden in inaccessible paper files inhospital and physician practices around the country and tens of millionsof dollars are wasted annually in trying to manage this paper nightmare.The need for a solution is staggering, and yet no one has yet solvedthis puzzle. Why? The answer lies in a deep understanding of physicianpractice mechanics and physician culture. Doctors know they have aproblem and are indeed in pain. But the pain of the solutions offeredhave to date been greater than the pain of the existing problem.

[0005] The scope of the problem can be understood by realizing thatphysicians represent merely one type of service provider that isimpossibly busy. In many industries, the service provider sees patientsor clients non-stop from the time they arrive at their offices until thetime they go home. Sixty hour weeks are the norm and their focus duringthat time is the patient or client; relating to the patient or client,evaluating the patient or client, determining the patient's or client'sproblems, offering a possible solution, implementing a plan, andexplaining this plan with reassurance to the patient or client. Inshort, the practice of medicine as many other services is very much arelational, interpretive and interpersonal affair. The art of medicineis at least as important as the science which is applied. After eachemotionally demanding and intellectually challenging encounter, thephysician then must document his thoughts, impression and plan, andjustify his reasoning in a legal document. With more patients stackingup to be seen, there is precious little time to accomplish this task, sothe vast majority of physicians must dictate the results of theencounter, often very rapidly, with no time left to edit or reviewbefore the next patient encounter. Physicians do not, will not, cannotlearn new methods of data entry that are less flexible and more timeconsuming. This is why today, less than 50% use any sort of electronicmedical record. Keyboards, pen charts and inaccurate, unedited voicerecognition programs cannot serve their needs and so they rely on anexisting transcription system and somewhat haphazard coding solution tohelp them document and justify each encounter. Physicians are willing topay for this service and pay well to relieve them of the burden oflearning a new career, i.e., documentation and coding. They are peopleoriented, not technology oriented and can and will pay to have someoneelse manage this aspect of healthcare. Many have mistakenly assumed thatif they build a data repository and provide the physicians with a screenand keyboard or a drop list and pen chart, that physicians will flock tothem in droves. Many such technologically advanced solutions exist now,and in large part they have been ignored or quickly abandoned. Thethreshold of entry is simply too great.

[0006] The provider will require service as part of the data capturesolution. Technology alone is not enough. Furthermore, doctors as wellas others often want local service. Someone they or their staff canpersonally call and hold accountable. Someone who does not hide behindthe veil of bureaucracy, but who is available and at risk in therelationship. In the medical application, today, the local medicaltranscriptionist fills that roll for creating edited paper documents.Mirroring the healthcare industry, medical transcriptionists are alsotypically small, fragmented, but local accountable shops which servephysician needs. They too, have a need. They realize that eventuallytechnology will replace them, and yet they don't know when. They realizethat their clients, the doctors, needs are only partially served by thepaper documents that they, the transcriptionist provide. Their verycareers are at stake, but because they are small and fragmented, they donot have the individual resources to solve doctors problems alone.Likewise, coding solutions are many, varied and fragmented and likewise,though they are aware of physician suffering; professional coders don'thave the insight or resources to comprehensively address the need.

[0007] In the context of sharing information, one of the problemsappears to be the fact that healthcare in general and physicianpractices in particular have not kept abreast of dramatic improvementsin the technology of data capture and management. The primary disconnectin our public health surveillance system remains the archaic system ofdata sharing between and among public health facilities, and asimportantly between the public health system and private practicingphysician as well as the private system of hospitals and clinics. InSeptember, 1999, the Senate Appropriations Committee requested, andsubsequently received a status report on public health's infrastructure.One of the primary needs identified in this document is the need forrobust information and data systems. As a result of that report, theHealth Alert Network became a key priority of both the Centers forDisease Control, and the Secretary of the Department of Health and HumanServices. The HAN was designed to meet the goals and recommendations setby the status report. One of three primary goals identified is asfollows:

[0008] “Goal number 2, robust information and data systems. GOAL: Eachhealth department will be able to electronically access and distributeup-to-date public health information and emergency health alerts,monitoring the health of communities, and assist in the detection of anemerging public health problem.

[0009] Recommendation 5: By 2010, ensure that all health departmentshave continuous high speed access to the internet and standard protocolsfor data collection, transport, electronic reporting and informationexchange that protects privacy and seamlessly connect local, state, andfederal data systems.

[0010] Recommendation 6: By 2010, ensure that all health departmentshave immediate online access to current public health recommendations,health and medical data, treatment uidelines and information on theeffectiveness of public health interventions.

[0011] Recommendation 7: By 2010, ensure that all health departmentshave the capacity to send and receive sensitive health information viasecure electronic systems and to broadcast emergency health alerts amonghospitals, medical centers, universities, and local public healthsystems and agencies.”

[0012] As to the medical application, clearly, these goals must beachieved to successfully leverage currently available technology andprotect the public health. The events of September 2001 however, make itequally clear that a fragmented state-by-state approach may get us thereby 2010, but we no longer enjoy the luxury of time. There is now animmediate and tangible threat that must be addressed in months, notyears. Furthermore, a key component in the electronic chain has not beenadequately addressed by these important recommendations or by the healthalert network. Namely, successful, accurate data capture by providers inthe field, both public and private. Unfortunately, technology solutionshave not been adopted by the vast majority of physicians who, for themost part, function independently. They are focused on patientinteraction and patient care, and keeping abreast of the rapid evolutionof medical knowledge and have had little time or patience for high techsolutions. As a result, incomplete fragments of patient information areburied in inaccessible paper files in hospital and physician practicesaround the country. Not only are tens of millions of dollars wasted intrying to manage this paper nightmare, but literally billions of dollarsare lost due to our inability to capture the data and glean criticalinformation on public health, treatment efficacy and the early detectionof health trends so that effective and rapid solutions can be deployed.If the information cannot be captured, it cannot be managed. If itcannot be managed, then care cannot be optimally improved. This simplelogic has profound implications for responsiveness to bioterroristthreats as well as the overall public health and safety.

DISCLOSURE OF INVENTION

[0013] Conceptually, the invention can be presented and understood froma variety of perspectives. With the understanding that such details arenot limiting, from one perspective it can be understood by reference tofour device-oriented aspects: a CE or other personal computingcapability recorder object, a functionality for precision coding throughsoftware and applications or the like, a separate CE or other personalcomputing capability such as an active-synch docking portal station, andeven file transfer protocols such as, in a medical application forexample, a health insurance portability and accountability act (HIPAA)compliant electronic signature aspect. Each of these aspects can ofcourse be presented and used separately or they may be combined with anycombination or permutation of these or other aspects to present anoverall system.

[0014] From a data creation perspective, the invention can be understoodas potentially encompassing a data tagging engine or otherfunctionality, perhaps or even functionality for parsing text to data,an application for dealing with a workflow digital stream such as in oneapplication for a medical transcriptionist or other such user, and aHIPAA compliant electronic note security transfer system. Again, each ofthese aspects can of course be presented and used separately or they maybe combined with any combination or permutation of these or otheraspects to present an overall system.

[0015] In addition, the invention can also be understood from aninformation flow or access perspective by reference to a digital stream,an Internet or other access database, an automated patient informationservices, and an interactive portal-based knowledge delivery system. Onemore, each of these aspects can of course be presented and usedseparately or they may be combined with any combination or permutationof these or other aspects to present an overall system.

[0016] One task in solving the problem is in simply capturing the data.The invention includes elements designed to tap into the vast amount ofdata and information that every moment in every office in America isdictated into a hand held portable tape recorder. The invention canmarry the two concept of coding and a checklist by placing the customtemplates directly on the screen of a hand held device such as a pocketPC. The invention can permit dictation directly “into” a pre-chosentemplate on a pocket PC, thus creating a digital .wav or other file ofstructured data that is then sent to a secure site such as via theInternet. An existing network of local independent transcriptionists canbe leveraged (in many cases it may be the medical transcriptionist thedoctor is already using) to access that structured data via the web andplug it into templated data fields as he or she is transcribing orediting the note. Surprisingly this can be accomplished simply andseamlessly. To the transcriptionist, it is an opportunity to provide asolution to their clients and save their careers doing much the samework they have always done, but they no longer need to drive to the siteof practice, pick up tapes and because the technology can interfaceseamlessly with existing practice management software: they also nolonger face the nightmare of matching demographic information todictated tapes. Now the data (coding, for example) can be shaped,captured, and structured in one seamless process that leverages existingnetworks and does so without increasing cost to the physician ordecreasing compensation to the transcriptionist. In fact, the technologycan be further leveraged to save the physician or other personsubstantial time (through the use of customized macros), money (throughmore accurate coding) and to relieve the burden of fragmented,inaccessible patient data by collecting the information in a secure siteaccessible from any Internet portal. Further, using an XML model andleveraging semi-automation, the invention can allow an interface withexisting systems. In one embodiment, wireless, portable remote hand heldunits can function as two-way data and information portals.

[0017] The hand held data entry device can be used to record pertinentdata of any kind such as disease surveillance data, ICD-9 or CPT codinginformation, physical examination, history or lab data. Because thesystem is portable and voice driven, and because the data can be shapedand structured with templates and checklists, there is optimumflexibility and a very flat learning curve (i.e., as easy as dictatinginto a tape recorder with a checklist at your fingertips) and therefore,should have high adoption rates. The data can also be securely stored ina central database in XML format where it can be aggregated and thenqueried to serve a variety of needs. Further, the template model canallow any entity to create custom templates and checklists downloadedfrom the web to shape data entry such that specific critical dataelements can be captured and tagged. In addition, the solution can workboth ways. Not only can customized templates be deployed via theInternet to all hand held data entry devices, but they can also receivehealth alerts, updates and pertinent templates immediately in real time,dramatically shortening the information cycle in both directions. Remotesystems with radio wireless technology can be used to keep remote sitesconnected to the central data processing repository and the health alertnetwork in real time.

BRIEF DESCRIPTION OF DRAWINGS

[0018]FIG. 1 is a schematic depiction of one embodiment of theinvention.

[0019]FIG. 2 is a block diagram of a portable capability in oneembodiment.

[0020]FIG. 3 is a block diagram of a transcriptionist system in oneembodiment.

[0021]FIG. 4 is a block diagram of a central data repository in oneembodiment.

[0022]FIG. 5 is a conceptual depiction of a tagged structured data inone embodiment.

MODES FOR CARRYING OUT THE INVENTION

[0023] From a more general view, the invention involves systems,methods, and devices to create structured data, that is data which is ina format that it can be readily used in a particular environment. Thesystem is designed to provide an easily used data creation process wherethe initial content generator need not have any specialized knowledge.It is designed to permit verbal information entry and to take that inputand proceed through a process whereby an end result is a perhaps even ahighly structured database (1) of information, perhaps even includingembedded data tags (2) or other structure which can enable moreappropriate—or more easy—use of the data. As should be easilyappreciated, the invention has application to a variety of fields.Literally any field in which information is generated and is desired tobe used may benefit to some degree by the various elements of theinvention. In this regard, it should also be understood that althoughthe invention will frequently be explained in the context of a medicalapplication—itself representing a new and unique use for such new andunique techniques—such is not intended to be limiting.

[0024] Perhaps the most tangible aspect of an embodiment is the use ofsome type of computing device to permit verbal data entry by a user whohas content contributions to make. The computing device, perhaps may bea portable computing device, such as a digital recorder or the like. Itmay even be a hand held data entry device (3) with somewhat limitedcapability. As explained below, this first computing device may even beaugmented by other, more full featured devices or capabilities.

[0025] In one example, the hand held data entry device (3) may be a CEor other personal computing capability recorder object. This aspect ofthe invention generally relates to and may include a COM (Common ObjectModel) software component object perhaps written in C++ or the like andcompiled as a COM object for distributed use in building applicationswhich may require or find useful the recorder functionality.Specifically, this element of the invention may focus on and may providefor designing, for coding, and for compiling a new or other COM objectthat may possess the desired functionality for use in applications whichmay require or find useful a digital recording functionality embedded ina CE-based or other such database form.

[0026] In addition, this element of the invention may include an abilityto add a recorder object into an application that has the desiredfunctionality to start, stop, pause, or utilize a slide bar to thedesired point in the record. It may serve to capture voice in a digitalformat (such *.wav, MP3, or otherwise) perhaps in a designer-variablebut acceptable quality range. It may use an optimized CODEC to balanceaudio quality, digital compression ratio, and optimal size of theresulting *.wav file.

[0027] A functionality for precision coding through software andapplications may be included at a variety of levels. This aspect of theinvention generally relates to and may include a database form developedfor Windows CE Pocket PC or other such devices. It may have embeddedprompts (4), again at multiple levels, built into the pick lists thatmay assist the health care or other such professional or user (5) toselect the optimum, accurate, and precise codes in support of themedical or other such record or data requirements. In a medicalapplication, such coding may be specified by the American MedicalAssociation (AMA) or other directing body. Specifically, this aspect ofthe invention may focus upon programming techniques and toolapplications that may embed data elements and schema into CE-based orother such forms with application software code that may prompt the userto interactively enter ‘elements’ (aka data) and ‘SUBMITS’ (aka ‘committo the database’). These may act to build a coding outline for use inthe dictation (e.g., voice capture to *.wav file) module.

[0028] Perhaps one of the most significant problems that this inventionaddresses is to put the immense coding options rule set, such as may bespecified by the AMA or otherwise, into the hands of the physician orother user (5) on a mobile, portable, or even hand held device at thepoint of use or care where the physician or other person can chooseelements for the patient exam or other event from a pick list or a checklist. This may include prompts (4) and may build an interactive outlinethat may serve as a template to dictate into a voice-captured filestored as a *.wav format for transcription.

[0029] Referring to FIG. 1, it can be seen that the overall system mayinvolve several elements which each supply different functionality forthe ultimate end result. In a basic form, the system may permit a user(5) to provide verbal information (6) that is captured by a first devicesuch as the hand held data entry device (3). This hand held data entrydevice (3) may then accomplish some function and then may provide andreceive information from a separate computing device. This may include ainserted code transcription system (7), which may itself have atranscriptionist input element (8) whereby even more traditionaltranscription input can be provided. To facilitate the creation of thedesired structured data, there may also be included, at some level, atag element, such as an extensible markup language generator (9).Finally, in this embodiment, there may even be another capability fortotal storage, analysis, and use of aggregate information (10). This mayexist at any level, including but not limited to that of a centralauthority (11) or the like.

[0030] A purpose of the overall system is, of course, to createstructured data appropriate to a particular data context. In order tofacilitate this, and as depicted in FIG. 2, embodiments may include amemory or other item which includes a stored data context element (12).This element may assist the user (5) in providing appropriate substance.It may also aid in creating structured data as explained below. To serveany of these purposes, it may be configured as a display to which theuser (5) may refer during his or her creation of verbal input. This mayaid in the creation of appropriate verbal information and may thus serveto assure the existence of appropriate input.

[0031] As should be understood, this can be varied greatly dependingupon the particular data needs. Thus the term data context is intendedto encompass any aspect which assist in the creation of an appropriateinput. This can range from simple pick lists, to checklists, to highlyspecialized inputs. All that is necessary is that the element or stepserve to aid in the desired creation to be considered as providing acontext within which the information is utilized or generated. Perhaps amore easily understood embodiment of this general concept is thepotential of using a visual display (13) as a context element. As such,it can be understood that the visual display can serve to guide the user(5). By selection of the appropriate information, it may even serve as adata entry influence material display. Its information can thus serve asdata entry influence material. By establishing such material ascorrelated to the data context, it can serve to shape the entry asdesired.

[0032] There are, of course, many ways in which to correlate orcoordinate the display to the data context. The context itself may bedesigned as a data input need context, as a data information needcontext, as a user reminder context, as a context designed to holdparamount the currency of information, as a statistical input needcontext, or even as a near real time statistical generated need context.All of this can be created using the principles of a document typedefinition structure. It could even act to prompt the generation of datawhich meets a particular document type definition. The context couldprovide for field segmented information, for ordering information, oreven for sequencing through field segmented information.

[0033] An aspect of the invention is the possibility of making the datacontext information available to the user (5) at the time of verbalinformation generation. In one embodiment, this may be accomplished byhaving the data context information controlled by a first computingdevice, such as the hand held computing device (3). This could aid theuser (5) in ordering the information verbally generated, in sequencingthrough appropriate data fields, or in providing the appropriate formatof information. Thus, the structured data could be arranged in a fieldformat, an ordered format, a subcontext format, a meta language format,and even an embedded code format. Importantly each of these wide rangingtypes of desired end result could be supported by the device at the timeof dictation. The data entry influence material could be checklistmaterial, pick list material, entry prompt information, or any othertype of information as it is the resultant structured data which isdesired, not the means of achieving it. Through appropriate file orscreen creation, the software subroutines could serve as an entry orderelement, a sequenced field element, a document type definition structureelement, a document type definition structure prompt, a field segmenteddisplay or any other type of element.

[0034] As mentioned earlier, this invention can be configured for agreat variety of applications. Thus the data context element can be setup as a medical diagnosis information element, a patient diagnosisinformation element, a medical insurance information element, a exoticmedical event information element (such as prompting for appropriatediagnosis of anthrax or another unusual and perhaps hard to discernevent or the like), as bioweapon diagnosis information element, orotherwise.

[0035] An important feature is the invention's ability to use verbalinformation. An embodiment may accomplish this by converting at least aportion of the verbal input into representative data or even digitalverbal data. There may be a verbal information entry element (14). Thismay serve as an input to a file generation element (15). The filegeneration element (15) may be programming, hard wiring, or read-onlymemory controlled capability within a first computing device'scapabilities (16). It may thus exist to be accomplished on a hand helddata entry device (3) or the like. As can be understood, the filegeneration element (15) can serve to generate any type of file from averbal or voice input. These could range from wave files (e.g., a filehaving at least some *.wav structure or compatibility and thus createdthrough a wave file generator), to MP3 files, to speech, recognitionfiles, the latter at present likely requiring too much computingcapability and speed to be practical but likely becoming more practicalas technology advances. Once generated, the verbal information file maybe stored—at least temporarily. Storage, temporary or otherwise, maylikely occur on the same hand held device at the same locations as thatwhere the dictation occurs. This may be accomplished by providing averbal information memory element (17) and a verbal information captureelement (20) which together may serve to capture the verbal informationin some form.

[0036] Even at the point of data creation it is possible to begin theprocess of creating actual structured data. This could be accomplishedby creating the data in a tagged format from the outset. Where the firstcomputing device's capabilities (16) are not sufficient to generate tags(as likely with present technology), the system may accept user input asan instruction to insert an appropriate tag. This input may take anyform, however, in its most simplistic form it may be a key stroke ortouch pad click which tells the hand held data entry device (3) that aspecific item has just been or is about to be entered. Such an inputcould be considered a binary (that is discretely determined) user inputwith the input element and the related subroutine to recognize it actingas a binary input element (19). This could then insert a preliminary orother tag (2) into the stream of dictation and could serve as astructured data information insertion element (21). This could thusresult in the insertion of even partial data structure information bythe hand held data entry device (3). Such a tag could of course serve toaid a transcriptionist in understand the type of data about to be orjust dictated. If so configured, the information stored in the verbalinformation memory element (17) might even be some type of compositestructured data—part verbal and part inserted code with the memoryserving as a hand held composite data memory. Thus the hand held dataentry device (3), could include at least a first part of a structureddata establishment element (18) perhaps as a partial structured datainformation insertion element.

[0037] As mentioned, the end result is the creation of structured data.This may be accomplished with a data tagging engine or even by parsingtext to data. This aspect of the invention generally relates to and mayinclude a set of proprietary wrappers around proprietary orindustry-standard computerized meta-languages, including but not limitedto SGML and it's subset XML, that may enable the creation of a medicalor other note XML (Extensible Mark-up Language) schema, perhapsincluding DTD (Document Type Definition), and XSLT (ExtensibleStylesheet Language Transformations) specifications. Specifically, thisaspect of the invention may focus on shaping information from a business‘use-case’ into a content-driven meta language to capture a variety ofdescriptive aspects for the data element of specific, detailed interest.

[0038] Perhaps one of the most significant problems that this inventionmay address is the functionality to shape business knowledge or otherinformation from a variety of domains, or foci, that are typicallycaptured as text, and potentially to create a uniform meta language thatdescribes the data and allows for the text-based information to beparsed into data elements which may be captured in a database forstorage and retrieval.

[0039] This can be accomplished by transforming the verbal informationinto structured data within the desired data context. Since thepoint-of-dictation device may have limited capability, a secondcomputing device, perhaps a full featured computing device may be usedto accomplish this more demanding function. For efficiency this may beaccomplished at a second location or even on a second computing devicewhere specialized transcriptionists are stationed. Thus the seconddevice could include a second part of a structured data establishmentelement (18).

[0040] As mentioned earlier and as illustrated in FIG. 3, this secondcomputing device may be configured as part of an inserted codetranscription system (7), that it may be configured to facilitate oraccomplish not only the conversion of verbal information into text butalso an associated insertion of structured data codes or the like aswell. Both the conversion to text and the insertion of codes may beaccomplished automatically, manually, or by a hybrid system where atranscriptionist (such as a skilled medical transcriptionist orprofessional coder) is available to make the appropriate judgment orinsert the appropriate codes or tags as required. This can beaccomplished by providing the transcriptionist input element (8)mentioned earlier whereby transcriptionist tagging can occur. As can beappreciated, there may also be-provided prompts (4) or the like in theinserted code transcription system (7) which may be triggered byanalysis or by inserted codes or the like to aid the transcriptionist.All this may be controlled by the second computing device's capabilities(22) such that the system acts to establish tagged structured datawithin the data context or to establish structured data in a taggedformat.

[0041] Once fully created, this element may create the structured data;this may be stored in a structured data memory (23). By appropriatedesign, the system may provide for the creation of structured data for aparticular data context. As such the system may serve as or include adata context configured structured data establishment element (24). Whenconfigured for the input of particular tags or codes which are tailoredto the appropriate data context the system may serve as or include adata context configured tagged structured data establishment element.For accountability or original data retention, the system may include inthe structured data original unaltered verbal information which may bestored in a unaltered verbal information storage element. As depicted inFIG. 5, this could result in including at least a portion of the digitalverbal data originally captured within the structured data.

[0042] The system could be configured to create multiple structured dataformats as well. This might be helpful for various jurisdictionalrequirements (insurance, CDC, etc.) and might result in the inclusion ofa multiple data structure establishment element such as an appropriatesubroutine or otherwise. For compatibility, a common coding format suchas extensible markup language (XML) format could be used. By properdesign or programming, the software or hardware might provide a taggeddata input (25), perhaps such as an extensible markup languagegenerator.

[0043] The medical or other transcriptionist may work with a workflowdigital stream application or an application for dealing with a workflowdigital stream. This aspect may generally relate to and may includecapability directed to automating the workflow process for adigital-stream dictation environment. This may be accomplished bydigital-streaming technology, databasing applications, and/or Internetaccess computing environments. Specifically, this aspect may focus on orprovide for any of the following: for automating the workflow processfor digital transcriptionists along a continuum staring with Internet toaccess digitized voice files in a *.wav format, for storage of the *.wavfile in a database for security and distribution, for retrieval andtranscription processing into a text file (*.rtf format), for storage ofthe text file (and XML file counterpart) in a SQL (Structured QueryLanguage) database or the like, and for delivery back to the clientusing the same, secure Internet connection at the start of the process.

[0044] In systems which utilize separate locations or which store orprovide end structured data to a separate location, it can be helpful toinclude transfer capability. A data transfer element (26) may exist atseveral levels. Transfer from the hand held data entry device (3) to theinserted code transcription system (7) may be automatic and as mentionedlater can be accompanied by an upload of some sort as well. Forconvenience, the system may be designed to facilitate a wireless mannerof transfer, an Internet manner of transfer, and even a cellulartelephone system based manner of transfer. Appropriate elements could beincluded such as a wireless transfer element, an Internet transferelement, and a cellular telephone system transfer element. This may beconfigured for and may serve primarily to transfer digital verbal data.Since sensitive data it may also be configured to securely transfer suchdata.

[0045] Transfer may also occur to/from other locations such as theinserted code transcription system, and even a central authority orrepository (11) where aggregate information (10) is stored andmaintained. Since medical or other data can be highly sensitive, thedata transfer element (26) may include an information stripper (27) forstripping individual identity information to create individual anonymousinformation at a particular location. Naturally any data transferelement (26) may be designed as a secure information transfer element.

[0046] The possibility of using an active-synch docking portal stationmay also be included. This aspect of the invention generally relates toand may include a proprietary component system to optimize theActive-Synch functionality for Windows CE or other such devices. It maybe designed to enable Healthcare or other professionals or users (5) toachieve the fastest and most secure synching process from the Pocket PC(Windows CE PDA device) or other such device to a local docking bay orconnected capability for caching and data transfer. Specifically, thisaspect of the invention may focus on designing and coding an optimal setof components into an application to enhance the standard functionalityof ActiveSynch, thereby allowing faster, more efficient, and more securetransfer of data from a CE-based PDA (personal digital assistant) orother such device to a PC-based docking or connection station, and fromthe docking or other station to a secure web site for storage and auditfunctionality. In this regard, another significant problems that thisinvention addresses is to create a custom application that adds to thefunctionality of the standard ActiveSynch function by addressing theneeds of large file transfer, speed and reliability of datatransmission, efficiency of moving large voice files, security of thefile transfer during transmission, and security of the file arriving atspecified-destinations with return receipt capabilities and audit traildocumentation.

[0047] Yet another aspect of the invention which may be understood in amedical context is the HIPAA-compliant electronic note security transfersystem or functionality. Generally, this aspect of the invention mayrelate to and provide for embedding the HIPAA (Health InsurancePortability and Accountability Act) security standards into anInternet-accessed electronic note delivery system for secure notetransfer and audit trail creation. Specifically, this aspect of theinvention may focus on and provide for building a secure documenttransfer application that utilizes any security specification, includingbut not limited to the most recent set of security specifications underHIPAA such hereby incorporated by reference. All may be provided forInternet transfer and database storage of highly sensitive, patientinformation files when the context relates to medical information.

[0048] The invention may be configured to create a secure applicationenvironment for document transfer across the Internet. This may be basedon the HIPAA or other such specifications. Configuration consistent withany mandate for all of health care to deploy the standards and an audittrail for the entire life of the document transfer may be automaticallyprovided.

[0049] For further security, an electronic signature aspect such as theHIPAA-compliant signature requirement may be included. This aspect ofthe invention may include an electronic signature software applicationto authenticate a Healthcare or other person or professional to a secureweb-site and to deliver established content to the properlyauthenticated user. Specifically, this aspect of the invention may focuson and provide a use of logging in through a user interface portal witha USER_NAME and PASSWORD or the like to authenticate to asecure-architecture system. While obtaining rights through appropriatepermissions, it may also gather access to all authenticated allocatedresources and may return a graphic image<graphic:signature>to closeout<contract>the transaction. It may also be designed to accommodate andcomply with electronic signature legislature specifications.

[0050] The invention may act to wrap a secure environment—and thedetails that describe and mandate a high level of security—around theneed to accept and close out a transaction (e.g., in the medicalexample, closing out a medical note for permanent entry into a patient'smedical record) with a necessary final step in the process, thesignature of the physician or other person of record and a visuallypleasing graphic signature to indicate document completion and closure.

[0051] The invention may also provide automation from ‘cradle-to-grave’for a voice file's transition into a text and data file to be deliveredto the client, while potentially also allowing the transcriptionist tohave custom tools all along the continuum that maximize the efficiencyand security of the document works-in-progress.

[0052] Once the structured data is created, it may be utilized in amultitude of fashions. An important possibility in this regard is thepossibility of providing for statistically analyzing not only theindividual record, but also the aggregate information created bymultiple stored structured data. Referring to FIG. 4, by compiling thevarious structured data into a database (1), the possibility ofanalyzing the database (1) and its aggregate information (10) can beunderstood. If, for example, the aggregate information (10) is stored ina database (1) at a central authority or repository (11), a dataanalysis element (28) such as a statistical analysis element orotherwise could review the data periodically or upon its entry into thedatabase (1). By presenting an aggregated multiple stored structureddata analysis element, neural network analysis element, trend analysiselement, or otherwise, the system could identify impacts or risks noteasily identified earlier. The techniques for analysis are, of course,varied ranging from statistical analysis, to trend analysis, toartificial intelligence analysis, to even neural network analysis. Fromthis, the system could identify relevant information as a result of suchanalysis. This could include unusually frequent symptoms or events,could correlate events by location or the like. In a conflictenvironment it could correlate battlefield events. In the homeland itcould correlate event by town, county, postal chain, by multiple postalchains, by governmental subdivision, by pre-established statisticalarea, or the like. It could also automatically provide information to acentral authority, perhaps such as the Center for Disease Control, theOffice of Homeland Security, a law enforcement agency, or even tomultiple law enforcement agencies simultaneously.

[0053] Of course the system could also provide information to the user.This could be accomplished by providing an information upload elementsuch as by making any one of the data transfer elements (26) serve in atwo way capacity as shown. In this manner the system could providerelevant information such as retroactive information (relating to aprior, just analyzed record) to the user. By uploading information, itwould also be possible to alert the user to a particular concern, toquery the user for additional information, or even to inform the user ofavailable information (such as information in a recommendation to changeprocedures for a particular event) as might be available from separateresources (29). Since the point-of-dictation device is alreadydisplaying information, it could display the potentially relevantinformation to the user. In the current terrorist and biological terrorenvironment, it could also provide healthcare provider alertinformation, symptom identification information, and even locationspecific information. The visual display (13) could thus be configuredas a user alert element or even a healthcare provider alert informationdisplay. For locational-dependent items, this may be facilitated byincluding the capability for GPS or other location data in thepoint-of-dictation device.

[0054] This upload of information could occur automatically or beprompted at any time such as by providing for an update of informationprior to a download, prior to use of the device, or even at the time ofa download. A central authority download element could be available atany time as well as a pre-utilization information upload element and adownload linked information upload element.

[0055] As mentioned earlier, the entire system could be configured for avariety of applications. It could be used to generate medical diagnosisinformation. In this fashion it might permit the user to dictate patientdiagnosis information, to dictate insurance claim information, todictate potentially exotic medical event information, to dictatepotential bioweapon symptom information, or to dictate Centers forMedicare and Medicaid Services (CMS)—secure information for laterstorage or analysis.

[0056] Other applications are also possible, including the possibilityof configuring the system to generate law enforcement relatedinformation. Law enforcement professionals could dictate crime sceneinformation, dictate potential terrorist event information, dictatepotential bioweapon event information, dictate accident eventinformation, or the like for similar storage and analysis.

[0057] Even general businesses could use the system by configuring it togenerate business information such as in dictating business billinginformation, dictating service provided information, or even dictatingmechanical or maintenance information. As o each of the foregoing,subroutines or hardware could be configured to serve as a lawenforcement information element, a potential bioweapon event informationelement, or the like.

[0058] In providing the information for research or use, a digitalstream, Internet access research database may be provided. This aspectmay provide capabilities for a seamless, easy-to-use, front-end accessinterface for clinical users to gain access to their private, detaildata sources and to public, summarized data sources from any browserenabled system. Specifically, it may focus on a compiled applicationthat is a front-end graphical user interface (GUI), and a set ofmiddleware application software functionalities that supply the businessrules for front-end user selections to interact with back end datastored in a SQL (Structured Query Language) database or the like.

[0059] The invention can be designed to simplify a clinical or otheruser's interaction with a standard browser by enabling applicationfunctionality that may tie the user's need to query the database, withthe allowable permissions, access, and usability of the data storedwithin the database.

[0060] Automated patient or other subject information services may alsobe provided. This aspect may provide capabilities for a seamless,easy-to-use, front-end access interface for patients to gain access totheir private, detailed medical or other record data sources and topublic, summarized data sources from any browser enabled system.Similarly to that mentioned above, this aspect may focus on or involve acompiled application that is a front-end graphical user interface (GUI),and a set of middleware application software functionalities that supplythe business rules for the front-end user selections to interact withthe back end data stored in a SQL (Structured Query Language) databaseor the like. In a medical application, the system may be designed tosimplify a patient's interaction with a standard browser by enablingapplication functionality that ties the user's need to query thedatabase, with the allowable permissions, access, and usability of thedata stored within the database. By providing an interactiveportal-based knowledge delivery system the system may provide aproprietary or other software application that may use the Internet togather user information and requests to build and package a customresponse in the form of an electronic deliverable.

[0061] A significant aspect of the invention it that it may simplify auser's interaction with a standard browser by enabling applicationfunctionality that ties the user's need to query the database, with theallowable permissions, access, and usability of the data stored withinthe database, and then has the database return an interactive documentto customize (or shape) the content into the desired deliverable for theclient.

[0062] As can be easily understood from the foregoing, the basicconcepts of the present invention may be embodied in a variety of ways.It involves both computer transcription and related techniques as wellas devices to accomplish the appropriate computer enhanced processes. Inthis application, the transcription techniques are disclosed as part ofthe results shown to be achieved by the various system described and assteps which are inherent to utilization. They are simply the naturalresult of utilizing the systems as intended and described. In addition,while some systems are disclosed, it should be understood that these notonly accomplish certain methods but also can be varied in a number ofways. Importantly, as to all of the foregoing, all of these facetsshould be understood to be encompassed by this disclosure.

[0063] The discussion included in this provisional application isintended to serve as a basic description. The reader should be awarethat the specific discussion may not explicitly describe all embodimentspossible; many alternatives are implicit. It also may not fully explainthe generic nature of the invention and may not explicitly show how eachfeature or element can actually be representative of a broader functionor of a great variety of alternative or equivalent elements. Again,these are implicitly included in this disclosure. Where the invention isdescribed in process-oriented terminology, each element of the processmay be implicitly performed by some device. Apparatus claims may notonly be included for such devices, but also method or process claims maybe included to address the functions the invention and each elementperforms. Neither the description nor the terminology is intended tolimit the scope of the claims which will be included in a full patentapplication.

[0064] It should also be understood that a variety of changes may bemade without departing from the essence of the invention. Such changesare also implicitly included in the description. They still fall withinthe scope of this invention. A broad disclosure encompassing both theexplicit embodiment(s) shown, the great variety of implicit alternativeembodiments, and the broad methods or processes and the like areencompassed by this disclosure.

[0065] Further, each of the various elements of the invention and claimsmay also be achieved in a variety of manners. This disclosure should beunderstood to encompass each such variation, be it a variation of anembodiment of any apparatus embodiment, a method or process embodiment,or even merely a variation of any element of these. Particularly, itshould be understood that as the disclosure relates to elements of theinvention, the words for each element may be expressed by equivalentapparatus terms or method terms—even if only the function or result isthe same. Such equivalent, broader, or even more generic terms should beconsidered to be encompassed in the description of each element oraction. Such terms can be substituted where desired to make explicit theimplicitly broad coverage to which this invention is entitled. As butone example, it should be understood that all actions may be expressedas a means for taking that action or as an element which causes thataction. Similarly, each physical element disclosed should be understoodto encompass a disclosure of the action which that physical elementfacilitates. Regarding this last aspect, as but one example, thedisclosure of the step of “transcribing” should be understood toencompass disclosure of a “transcriber” —whether explicitly discussed ornot—and, conversely, were there effectively disclosure of antranscriber”, such a disclosure should be understood to encompassdisclosure or the step of “transcribing” and even a “means fortranscribing”. Such changes and alternative terms are to be understoodto be explicitly included in the description.

[0066] Thus, support should be understood for any claiming of not onlythe listed claims, but also at least: i) each of the methods orprocesses as herein disclosed and described, ii) the related device toaccomplish such processes, iii) similar, equivalent, and even implicitvariations of each of these devices and methods, iv) those alternativedesigns which accomplish each of the functions shown as are disclosedand described, v) those alternative designs and methods which accomplisheach of the functions shown as are implicit to accomplish that which isdisclosed and described. vi) each feature, component, and step shown asseparate and independent inventions, vii) the applications enhanced bythe various systems or components disclosed, viii) the resultingproducts produced by such systems or components, ix) methods andapparatuses substantially as described hereinbefore and with referenceto any of the accompanying examples, x) the various combinations andpermutations of each of the elements disclosed, xi) processes performedwith the aid of or on a computer as described throughout the abovediscussion, xii) a programmable apparatus as described throughout theabove discussion, xiii) a computer readable memory encoded with data orprograms to direct a computer comprising means or elements whichfunction as described throughout the above discussion, xiv) a computerconfigured as herein disclosed and described, xv) individual or combinedsubroutines and programs as herein disclosed and described, xvi) therelated methods disclosed and described, xvii) similar, equivalent, andeven implicit variations of each of these systems and methods, xviii)those alternative designs which accomplish each of the functions shownas are disclosed and described, xix) those alternative designs andmethods which accomplish each of the functions shown as are implicit toaccomplish that which is disclosed and described, xx) each feature,component, and step shown as separate and independent inventions, andxxi) the various combinations and permutations of each of the above andany element claimed or disclosed. In this regard it should be understoodthat for practical reasons and so as to avoid adding potentiallyhundreds of claims, the applicant may have presented claims with initialdependencies only. Support should be understood to exist to the degreerequired under new matter laws—including but not limited to EuropeanPatent Convention Article 123(2) and United States patent Law 35 USC 132or other such laws—to permit the addition of any of the variousdependencies or other elements presented under one independent claim orconcept as dependencies or elements under any other independent claim orconcept.

[0067] Further, if or when used, the use of the transitional phrase“comprising” is used to maintain the “open-end” claims herein, accordingto traditional claim interpretation. Thus, unless the context requiresotherwise, it should be understood that the term “comprise” orvariations such as “comprises” or “comprising”, are intended to implythe inclusion of a stated element or step or group of elements or stepsbut not the exclusion of any other element or step or group of elementsor steps. Such terms should be interpreted in their most expansive formso as to afford the applicant the broadest coverage legally permissible.

[0068] The claims set forth in this specification by are herebyincorporated by reference as part of this description of the invention,and the applicant expressly reserves the right to use all of or aportion of such incorporated content of such claims as additionaldescription to support any of or all of the claims or any element orcomponent thereof, and the applicant further expressly reserves theright to move any portion of or all of the incorporated content of suchclaims or any element or component thereof from the description into theclaims or vice-versa as necessary to define the matter for whichprotection is sought by this application or by any subsequentcontinuation, division, or continuation-in-part application thereof, orto obtain any benefit of, reduction in fees pursuant to, or to complywith the patent laws, rules, or regulations of any country or treaty,and such content incorporated by reference shall survive during theentire pendency of this application including any subsequentcontinuation, division, or continuation-in-part application thereof orany reissue or extension thereon.

[0069] Any acts of law, statutes, regulations, or rules mentioned inthis application for patent, any patents, publications, prioritydocuments, or other references mentioned in this application for patentare hereby incorporated by reference. In addition, as to each term usedit should be understood that unless its utilization in this applicationis inconsistent with such interpretation, common dictionary definitionsshould be understood as incorporated for each term and all definitions,alternative terms, and synonyms such as contained in the Random HouseWebster's Unabridged Dictionary, second edition are hereby incorporatedby reference. Finally, the following references are hereby appended andhereby incorporated by reference, however, as to each, to the extentthat such information or statements incorporated by reference might beconsidered inconsistent with the pang of this/these invention(s) suchstatements are expressly not to be considered as made by theapplicant(s).

[0070] Finally, it should be noted that this application claims thebenefit of and makes priority claims to U.S. Patent Application Nos.60/246,328, 60/246,329, 60/246,381, filed on or about Nov. 7, 2000. Eachof these applications is hereby incorporated by reference.

1. A method of creating structured medical data comprising the steps of:a. establishing a data context within which information is utilized; b.visually displaying data entry influence material correlated to saiddata context on a first computing device; c. user generating verbalmedical information which is shaped to coordinate at least some degreeto said data context by said data entry influence material; d.converting at least a portion of said verbal medical information intodigital verbal data representative of at least a portion of said verbalmedical information on said first computing device; e. at leasttemporarily storing said digital verbal data on said first computingdevice; f. transferring said digital verbal data to a second computingdevice; and g. transforming said digital verbal data into structureddata by use of said second computing device.
 2. (Canceled)
 3. A methodof creating structured medical data as described in claim 2 wherein saidstep of transforming said digital verbal data into structured data byuse of said second computing device comprises the step of establishingstructured data in a tagged format.
 4. A method of creating structuredmedical data as described in claim 3 wherein said step of establishing adata context comprises the step of creating a document type definitionstructure.
 5. A method of creating structured medical data as describedin claim 1 and further comprising the step of analyzing a database ofsaid structured data by use of a process selected from a groupconsisting of: statistical analysis, trend analysis, artificialintelligence analysis, and neural network analysis.
 6. A method ofcreating structured medical data as described in claim 5, and furthercomprising the steps of: a. analyzing said structured data; b.identifying relevant information as a result of said analysis; and c.providing said relevant information to a user.
 7. A method of creatingstructured medical data as described in claim 5 and further comprisingthe step of providing information to a central authority selected from agroup consisting of: the Center for Disease Control, the Office ofHomeland Security, a law enforcement agency, and multiple lawenforcement agencies.
 8. A method of creating structured medical data asdescribed in claim 7 wherein said step of user generating verbal medicalinformation comprises the step of dictating potential bioweapon symptominformation.
 9. A method of creating structured medical data asdescribed in claim 6 wherein aid step of providing said relevantinformation to a user comprises the step of displaying informationselected from a group consisting of: healthcare provider alertinformation, symptom identification information, location specificinformation, and entry prompt information.
 10. A method of creatingstructured data comprising the steps of: a. establishing a data contextwithin which information is utilized; b. visually displaying data entryinfluence material correlated to said data context; c. user generatingverbal information which is shaped to coordinate at least some degree tosaid data context by said data entry influence material; c. convertingat least a portion of said verbal information into digital verbal datarepresentative of at least a portion of said verbal information; d. atleast temporarily storing said digital verbal data; and e. transformingsaid digital verbal data into structured data within said data context.11. A method of creating structured data as described in claim 10wherein said step of visually displaying data entry influence materialcorrelated to said data context comprises the step of visuallydisplaying data entry influence material on a computing device, andwherein said step of converting at least a portion of said verbalinformation into digital verbal data representative of at least aportion of said verbal information comprises the step of converting atleast a portion of said verbal information into digital verbal data onthe same computing device.
 12. A method of creating structured data asdescribed in claim 11 wherein said steps of visually displaying dataentry influence material on a computing device, and said step ofconverting at least a portion of said verbal information into digitalverbal data on the same computing device each comprise the step ofutilizing a portable computing device.
 13. A method of creatingstructured data as described in claim 12 and further comprising the stepof transferring said digital verbal data from said portable computingdevice to a second computing device.
 14. A method of creating structureddata as described in claim 13 wherein said step of transforming saiddigital verbal data into structured data within said data contextcomprises the step of utilizing said second computing device.
 15. Amethod of creating structured data as described in claim 13 wherein saidstep of transferring said digital verbal data from said portablecomputing device to a second computing device comprises the step oftransferring said digital verbal data in manner selected from a groupconsisting of a wireless manner of transfer, an internet manner oftransfer, and a cellular telephone system based manner of transfer.16-24. (Canceled)
 25. A method of creating structured informationcomprising the steps of: a. visually displaying data entry influencematerial on a hand held data entry device; b. user generating verbalinformation which is shaped to at least some degree by said data entryinfluence material; c. capturing at least a portion of said verbalinformation on said hand held data entry device; d. inserting at leastsome data structure information with at least a portion of said capturedverbal information on said hand held data entry device to createcomposite structured data; e. at least temporarily storing saidcomposite structured data on said hand held data entry device.
 26. Amethod of creating structured data as described in claim 25 wherein saidstep of inserting at least some data structure information with at leasta portion of said captured verbal information on said hand held dataentry device to create composite structured data comprises the step ofinserting partial data structure information to create compositestructured data.
 27. A method of creating structured data as describedin claim 26 and further comprising the step of transferring saidcomposite structured data from said hand held data entry device to afull featured computing device.
 28. A method of creating structured dataas described in claim 25 wherein said step of capturing at least aportion of said verbal information on said hand held data entry devicecomprises the step of generating a wave file on said hand held dataentry device.
 29. A method of creating structured data as described inclaim 27 and further comprising the step of transforming digital verbaldata into structured data within a data context at said full featuredcomputing device.
 30. A method of creating structured data as describedin claim 27 wherein said step of transferring said composite structureddata from said hand held data entry device comprises the step oftransferring said composite structured data in manner selected from agroup consisting of a wireless manner of transfer, an internet manner oftransfer, and a cellular telephone system based manner of transfer.31-150. (Canceled)